Eosinophilic gastroenteritis: Difference between revisions
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==Classification== | ==Classification== | ||
Eosinophilic gastroenteritis can be subdivided into three groups according to the Klein classification:<ref name="klein" /><ref name="talley">{{cite journal| author=Talley NJ, Shorter RG, Phillips SF, Zinsmeister AR| title=Eosinophilic gastroenteritis: a clinicopathological study of patients with disease of the mucosa, muscle layer, and subserosal tissues. | journal=Gut | year= 1990 | volume= 31 | issue= 1 | pages= 54-8 | pmid= 2318432 | doi= | pmc=1378340 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2318432 }} </ref><ref name="baig">{{cite journal| author=Baig MA, Qadir A, Rasheed J| title=A review of eosinophilic gastroenteritis. | journal=J Natl Med Assoc | year= 2006 | volume= 98 | issue= 10 | pages= 1616-9 | pmid=17052051 | doi= | pmc=2569760 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17052051 }} </ref><ref name="pmid8420276">{{cite journal| author=Lee CM, Changchien CS, Chen PC, Lin DY, Sheen IS, Wang CS et al.| title=Eosinophilic gastroenteritis: 10 years experience. | journal=Am J Gastroenterol | year= 1993 | volume= 88 | issue= 1 | pages= 70-4 | pmid=8420276 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8420276 }} </ref> | Eosinophilic gastroenteritis can be subdivided into three groups according to the Klein classification:<ref name="klein" /><ref name="talley">{{cite journal| author=Talley NJ, Shorter RG, Phillips SF, Zinsmeister AR| title=Eosinophilic gastroenteritis: a clinicopathological study of patients with disease of the mucosa, muscle layer, and subserosal tissues. | journal=Gut | year= 1990 | volume= 31 | issue= 1 | pages= 54-8 | pmid= 2318432 | doi= | pmc=1378340 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2318432 }} </ref><ref name="baig">{{cite journal| author=Baig MA, Qadir A, Rasheed J| title=A review of eosinophilic gastroenteritis. | journal=J Natl Med Assoc | year= 2006 | volume= 98 | issue= 10 | pages= 1616-9 | pmid=17052051 | doi= | pmc=2569760 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17052051 }} </ref><ref name="pmid8420276">{{cite journal| author=Lee CM, Changchien CS, Chen PC, Lin DY, Sheen IS, Wang CS et al.| title=Eosinophilic gastroenteritis: 10 years experience. | journal=Am J Gastroenterol | year= 1993 | volume= 88 | issue= 1 | pages= 70-4 | pmid=8420276 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8420276 }} </ref><ref name="pmid26054822" /> | ||
* '''Mucosal eosinophilic gastroenteritis''' | *'''Mucosal eosinophilic gastroenteritis''' | ||
# Most common subtype of eosinophilic gastroenteritis. | |||
# Mucosal infiltration by [[eosinophils]], and/or presence of mucosal [[edema]] on [[Barium|barium studies]]. | #Most common subtype of eosinophilic gastroenteritis. | ||
# Absent histological evidence of muscle infiltration. | #Mucosal infiltration by [[eosinophils]], and/or presence of mucosal [[edema]] on [[Barium|barium studies]]. | ||
# No evidence of [[gastrointestinal obstruction]] or eosinophilic [[ascites]]. | #Absent histological evidence of muscle infiltration. | ||
* '''Muscular eosinophilic gastroenteritis''' | #No evidence of [[gastrointestinal obstruction]] or eosinophilic [[ascites]]. | ||
# Documentation of complete/incomplete [[bowel obstruction]], and/or infiltration of the [[tunica muscularis]] by [[eosinophils]]. | |||
# No evidence of eosinophilic [[ascites]]. | *'''Muscular eosinophilic gastroenteritis''' | ||
* '''Subserosal eosinophilic gastroenteritis''' | |||
# Eosinophilic infiltration of the [[gut]] | #Documentation of complete/incomplete [[bowel obstruction]], and/or infiltration of the [[tunica muscularis]] by [[eosinophils]]. | ||
# | #No evidence of eosinophilic [[ascites]]. | ||
*'''Subserosal eosinophilic gastroenteritis''' | |||
#Eosinophilic infiltration of the [[gut]] | |||
#Presence of eosinophilic [[ascites]] (may occasionally progress to an eosinophilic [[pleural effusion]]) | |||
==Causes== | ==Causes== | ||
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==Risk Factors== | ==Risk Factors== | ||
* [[Allergy]]: A study conducted in 40 patients with eosinophilic gastroenteritis demonstrated a history of [[allergy]] in half of the patients.<ref name="talley"/> Food intolerance or [[allergy]] is more commonly seen in mucosal eosinophilic gastroenteritis, affecting over 50% of patients with mucosal disease according to a study.<ref name="talley"/> | |||
*[[Allergy]]: A study conducted in 40 patients with eosinophilic gastroenteritis demonstrated a history of [[allergy]] in half of the patients.<ref name="talley" /> Food intolerance or [[allergy]] is more commonly seen in mucosal eosinophilic gastroenteritis, affecting over 50% of patients with mucosal disease according to a study.<ref name="talley" /> | |||
==Pathophysiology== | ==Pathophysiology== | ||
===Pathogenesis=== | ===Pathogenesis=== | ||
* Eosinophilic gastroenteritis is a rare disease with poorly understood pathophysiology. | |||
* Eosinophils are normally seen in the entire [[GIT]] (except in the [[esophagus]]) of healthy individuals.<ref name="pmid26054822">{{cite journal| author=Uppal V, Kreiger P, Kutsch E| title=Eosinophilic Gastroenteritis and Colitis: a Comprehensive Review. | journal=Clin Rev Allergy Immunol | year= 2016 | volume= 50 | issue= 2 | pages= 175-88 | pmid=26054822 | doi=10.1007/s12016-015-8489-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26054822 }} </ref> | *Eosinophilic gastroenteritis is a rare disease with poorly understood pathophysiology. | ||
* In patients with eosinophilic gastroenteritis, there is varying degrees of increased eosinophilic infiltration of the [[Gastrointestinal tract|GIT]] (in the absence of other known causes of tissue [[eosinophilia]]).<ref name="pmid28299223">{{cite journal| author=Shetty V, Daniel KE, Kesavan A| title=Hematemesis as Initial Presentation in a 10-Week-Old Infant with Eosinophilic Gastroenteritis. | journal=Case Rep Pediatr | year= 2017 | volume= 2017 | issue= | pages= 2391417 | pmid=28299223 | doi=10.1155/2017/2391417 | pmc=5337357 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28299223 }} </ref><ref name="pmid26054822">{{cite journal| author=Uppal V, Kreiger P, Kutsch E| title=Eosinophilic Gastroenteritis and Colitis: a Comprehensive Review. | journal=Clin Rev Allergy Immunol | year= 2016 | volume= 50 | issue= 2 | pages= 175-88 | pmid=26054822 | doi=10.1007/s12016-015-8489-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26054822 }} </ref> | *Eosinophils are normally seen in the entire [[GIT]] (except in the [[esophagus]]) of healthy individuals.<ref name="pmid26054822">{{cite journal| author=Uppal V, Kreiger P, Kutsch E| title=Eosinophilic Gastroenteritis and Colitis: a Comprehensive Review. | journal=Clin Rev Allergy Immunol | year= 2016 | volume= 50 | issue= 2 | pages= 175-88 | pmid=26054822 | doi=10.1007/s12016-015-8489-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26054822 }} </ref> | ||
* Any part of the [[Gastrointestinal tract|GIT]] from the [[esophagus]] to the [[colon]] can be affected. Occasionally, eosinophilic gastroenteritis affects the entire [[gastrointestinal tract]].<ref name="talley"/> The [[stomach]] and proximal [[small intestine]] are most commonly affected, while the [[colon]] is usually the least affected part of the [[Gastrointestinal tract|GIT]].<ref name="pmid28299223"/><ref name="talley"/><ref name="pmid26054822"/> | *In patients with eosinophilic gastroenteritis, there is varying degrees of increased eosinophilic infiltration of the [[Gastrointestinal tract|GIT]] (in the absence of other known causes of tissue [[eosinophilia]]).<ref name="pmid28299223">{{cite journal| author=Shetty V, Daniel KE, Kesavan A| title=Hematemesis as Initial Presentation in a 10-Week-Old Infant with Eosinophilic Gastroenteritis. | journal=Case Rep Pediatr | year= 2017 | volume= 2017 | issue= | pages= 2391417 | pmid=28299223 | doi=10.1155/2017/2391417 | pmc=5337357 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28299223 }} </ref><ref name="pmid26054822">{{cite journal| author=Uppal V, Kreiger P, Kutsch E| title=Eosinophilic Gastroenteritis and Colitis: a Comprehensive Review. | journal=Clin Rev Allergy Immunol | year= 2016 | volume= 50 | issue= 2 | pages= 175-88 | pmid=26054822 | doi=10.1007/s12016-015-8489-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26054822 }} </ref> | ||
* The etiology of the excessive eosinophilic infiltration of the [[Gastrointestinal tract|GIT]] is not clear. Destruction of the [[Gastrointestinal tract|GIT]] [[epithelium]] caused by the release of eosinophilic basic protein and activated degranulating [[eosinophils]] has been proposed.<ref name="talley"/><ref name="pmid 11338074">{{cite journal| author=Tan AC, Kruimel JW, Naber TH| title=Eosinophilic gastroenteritis treated with non-enteric-coated budesonide tablets. | journal=Eur J Gastroenterol Hepatol | year= 2001 | volume= 13 | issue= 4 | pages= 425-7 | pmid= 11338074 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11338074 }} </ref> | *Any part of the [[Gastrointestinal tract|GIT]] from the [[esophagus]] to the [[colon]] can be affected. Occasionally, eosinophilic gastroenteritis affects the entire [[gastrointestinal tract]].<ref name="talley" /> The [[stomach]] and proximal [[small intestine]] are most commonly affected, while the [[colon]] is usually the least affected part of the [[Gastrointestinal tract|GIT]].<ref name="pmid28299223" /><ref name="talley" /><ref name="pmid26054822" /> | ||
* Inflammatory mediators such as [[TH2-cells|Th-2]] [[cytokines]] ([[IL-3]], [[IL-5]] and [[IL-13]]), [[eosinophils]], and eosinophilic mediators such as eotaxin have been strongly implicated.<ref name="pmid28299223" /><ref name="pmid26054822"/><ref name="baig"/> | *The etiology of the excessive eosinophilic infiltration of the [[Gastrointestinal tract|GIT]] is not clear. Destruction of the [[Gastrointestinal tract|GIT]] [[epithelium]] caused by the release of eosinophilic basic protein and activated degranulating [[eosinophils]] has been proposed.<ref name="talley" /><ref name="pmid 11338074">{{cite journal| author=Tan AC, Kruimel JW, Naber TH| title=Eosinophilic gastroenteritis treated with non-enteric-coated budesonide tablets. | journal=Eur J Gastroenterol Hepatol | year= 2001 | volume= 13 | issue= 4 | pages= 425-7 | pmid= 11338074 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11338074 }} </ref> | ||
* The inflammatory mediators associated with the pathogenesis of eosinophilic gastroenteritis have well established roles in the pathogenesis of [[allergy]] and [[asthma]]. A significant number of patients with eosinophilic gastroenteritis have also been documented to have [[allergies]]/allergy-related disorders, suggesting a [[hypersensitivity reaction]] is involved in the pathogenesis of eosinophilic gastroenteritis.<ref name="pmid28299223" /><ref name="baig"/> | *Inflammatory mediators such as [[TH2-cells|Th-2]] [[cytokines]] ([[IL-3]], [[IL-5]], [[GM-CSF]] and [[IL-13]]), [[monocyte]] generating [[chemokines]] such as [[Interleukin 8|IL-8]], [[monocyte]] chemotactic proteins, [[mast cells]], [[granulocytes]], [[eosinophils]], and eosinophilic mediators such as eotaxin have been strongly implicated.<ref name="pmid28299223" /><ref name="pmid26054822" /><ref name="baig" /> | ||
*The inflammatory mediators associated with the pathogenesis of eosinophilic gastroenteritis have well established roles in the pathogenesis of [[allergy]] and [[asthma]]. A significant number of patients with eosinophilic gastroenteritis have also been documented to have [[allergies]]/allergy-related disorders, suggesting a [[hypersensitivity reaction]] is involved in the pathogenesis of eosinophilic gastroenteritis.<ref name="pmid28299223" /><ref name="baig" /> | |||
==Differentiating {{PAGENAME}} from Other Diseases== | ==Differentiating {{PAGENAME}} from Other Diseases== | ||
Diseases with peripheral [[eosinophilia]] and gastrointestinal symptoms should be differentiated from eosinophilic gastroenteritis. It is also important to consider eosinophilic gastroenteritis in the differential diagnosis of unexplained gastrointestinal symptoms (even when peripheral [[eosinophilia]] is not present). Most diseases that can manifest with gastrointestinal symptoms and peripheral [[eosinophilia]] are easily differentiated from eosinophilic gastroenteritis via detailed history taking, laboratory investigations, and histologic examination of endoscopic biopsies.<ref name="baig"/><ref name="pmid26054822"/> Some of these diseases include:<ref name="baig"/><ref name="pmid26054822"/><ref name="pmid7572911">{{cite journal| author=Matsushita M, Hajiro K, Morita Y, Takakuwa H, Suzaki T| title=Eosinophilic gastroenteritis involving the entire digestive tract. | journal=Am J Gastroenterol | year= 1995 | volume= 90 | issue= 10 | pages= 1868-70 | pmid=7572911 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7572911 }} </ref><ref name="pmid15492606">{{cite journal| author=Barbie DA, Mangi AA, Lauwers GY| title=Eosinophilic gastroenteritis associated with systemic lupus erythematosus. | journal=J Clin Gastroenterol | year= 2004 | volume= 38 | issue= 10 | pages= 883-6 | pmid=15492606 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15492606 }} </ref> | Diseases with peripheral [[eosinophilia]] and gastrointestinal symptoms should be differentiated from eosinophilic gastroenteritis. It is also important to consider eosinophilic gastroenteritis in the differential diagnosis of unexplained gastrointestinal symptoms (even when peripheral [[eosinophilia]] is not present). Most diseases that can manifest with gastrointestinal symptoms and peripheral [[eosinophilia]] are easily differentiated from eosinophilic gastroenteritis via detailed history taking, laboratory investigations, and histologic examination of endoscopic biopsies.<ref name="baig" /><ref name="pmid26054822" /> Some of these diseases include:<ref name="baig" /><ref name="pmid26054822" /><ref name="pmid7572911">{{cite journal| author=Matsushita M, Hajiro K, Morita Y, Takakuwa H, Suzaki T| title=Eosinophilic gastroenteritis involving the entire digestive tract. | journal=Am J Gastroenterol | year= 1995 | volume= 90 | issue= 10 | pages= 1868-70 | pmid=7572911 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7572911 }} </ref><ref name="pmid15492606">{{cite journal| author=Barbie DA, Mangi AA, Lauwers GY| title=Eosinophilic gastroenteritis associated with systemic lupus erythematosus. | journal=J Clin Gastroenterol | year= 2004 | volume= 38 | issue= 10 | pages= 883-6 | pmid=15492606 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15492606 }} </ref> | ||
* [[Intestinal parasites|Intestinal parasitic infections]]: [[Stool examination]] for [[ova]] and [[parasites]] can be utilized for diagnosis. | *[[Intestinal parasites|Intestinal parasitic infections]]: [[Stool examination]] for [[ova]] and [[parasites]] can be utilized for diagnosis. | ||
* [[Inflammatory bowel disease|Inflammatory bowel disease (IBD)]]: Biopsy can easily distinguish [[Inflammatory bowel disease|IBD]] from eosinophilic gastroenteritis. | *[[Inflammatory bowel disease|Inflammatory bowel disease (IBD)]]: Biopsy can easily distinguish [[Inflammatory bowel disease|IBD]] from eosinophilic gastroenteritis. | ||
* [[Hypereosinophilic syndrome]]: It usually presents with markedly elevated peripheral [[eosinophilia]] (>1500 cells/μL) for more than six consecutive months. Eosinophilic gastroenteritis is observed in association with eosinophilic infiltration of other organ systems. The organs that are commonly affected in [[hypereosinophilic syndrome]] are the [[lungs]], [[skin]], [[GIT]], [[kidneys]], [[heart]] and [[brain]]. | *[[Hypereosinophilic syndrome]]: It usually presents with markedly elevated peripheral [[eosinophilia]] (>1500 cells/μL) for more than six consecutive months. Eosinophilic gastroenteritis is observed in association with eosinophilic infiltration of other organ systems. The organs that are commonly affected in [[hypereosinophilic syndrome]] are the [[lungs]], [[skin]], [[GIT]], [[kidneys]], [[heart]] and [[brain]]. | ||
* [[Helicobacter pylori]] infecton: This is not a common cause of tissue [[eosinophilia]]. [[Histology]] of gastric biopsies using [[silver staining]] can rule out [[Helicobacter pylori]] infection. | *[[Helicobacter pylori]] infecton: This is not a common cause of tissue [[eosinophilia]]. [[Histology]] of gastric biopsies using [[silver staining]] can rule out [[Helicobacter pylori]] infection. | ||
* [[Vasculitides|Vasculitic disorders]] such as [[Churg-Strauss syndrome|churg-strauss syndrome]] and [[polyarteritis nodosa]]: Eosinophilic infiltration of small [[blood vessels]] in the [[GIT]] is seen. [[Autoantibodies]] are usually present and markers of [[inflammation]] are elevated. | *[[Vasculitides|Vasculitic disorders]] such as [[Churg-Strauss syndrome|churg-strauss syndrome]] and [[polyarteritis nodosa]]: Eosinophilic infiltration of small [[blood vessels]] in the [[GIT]] is seen. [[Autoantibodies]] are usually present and markers of [[inflammation]] are elevated. | ||
* [[Connective tissue disorders]] such as [[scleroderma]], [[polymyositis]], [[dermatomyositis]], [[systemic lupus erythematosus]]. | *[[Connective tissue disorders]] such as [[scleroderma]], [[polymyositis]], [[dermatomyositis]], [[systemic lupus erythematosus]]. | ||
* [[Celiac disease]]: [[Serology]] and [[biopsy]] can differentiate it from eosinophilic gastroenteritis. | *[[Celiac disease]]: [[Serology]] and [[biopsy]] can differentiate it from eosinophilic gastroenteritis. | ||
* [[Drugs]]: Some medications have been documented to cause eosinophilic infiltration of the [[GIT]]. Examples of such medications include [[gold compounds]], [[rifampicin]], [[clofazimine]], [[gemfibrozil]], [[azathioprine]], [[enalapril]], [[naproxen]] and other [[NSAIDS]], [[interferon]], [[tacrolimus]], etc.<ref name="pmid12118924">{{cite journal| author=Shakeer VK, Devi SR, Chettupuzha AP, Mustafa CP, Sandesh K, Kumar SK et al.| title=Carbamazepine-induced eosinophilic enteritis. | journal=Indian J Gastroenterol | year= 2002 | volume= 21 | issue= 3 | pages= 114-5 | pmid=12118924 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12118924 }} </ref><ref name="pmid7968003">{{cite journal| author=Lange P, Oun H, Fuller S, Turney JH| title=Eosinophilic colitis due to rifampicin. | journal=Lancet | year= 1994 | volume= 344 | issue= 8932 | pages= 1296-7 | pmid=7968003 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7968003 }} </ref><ref name="pmid16340639">{{cite journal| author=Jiménez-Sáenz M, González-Cámpora R, Linares-Santiago E, Herrerías-Gutiérrez JM| title=Bleeding colonic ulcer and eosinophilic colitis: a rare complication of nonsteroidal anti-inflammatory drugs. | journal=J Clin Gastroenterol | year= 2006 | volume= 40 | issue= 1 | pages= 84-5 | pmid=16340639 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16340639 }} </ref><ref name="pmid2220886">{{cite journal| author=Bridges AJ, Marshall JB, Diaz-Arias AA| title=Acute eosinophilic colitis and hypersensitivity reaction associated with naproxen therapy. | journal=Am J Med | year= 1990 | volume= 89 | issue= 4 | pages= 526-7 | pmid=2220886 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2220886 }} </ref><ref name="pmid10905364">{{cite journal| author=Kakumitsu S, Shijo H, Akiyoshi N, Seo M, Okada M| title=Eosinophilic enteritis observed during alpha-interferon therapy for chronic hepatitis C. | journal=J Gastroenterol | year= 2000 | volume= 35 | issue= 7 | pages= 548-51 | pmid=10905364 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10905364 }} </ref><ref name="pmid10963515">{{cite journal| author=Lee JY, Medellin MV, Tumpkin C| title=Allergic reaction to gemfibrozil manifesting as eosinophilic gastroenteritis. | journal=South Med J | year= 2000 | volume= 93 | issue= 8 | pages= 807-8 | pmid=10963515 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10963515 }} </ref><ref name="pmid8470652">{{cite journal| author=Ravi S, Holubka J, Veneri R, Youn K, Khatib R| title=Clofazimine-induced eosinophilic gastroenteritis in AIDS. | journal=Am J Gastroenterol | year= 1993 | volume= 88 | issue= 4 | pages= 612-3 | pmid=8470652 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8470652 }} </ref><ref name="pmid11468446">{{cite journal| author=Barak N, Hart J, Sitrin MD| title=Enalapril-induced eosinophilic gastroenteritis. | journal=J Clin Gastroenterol | year= 2001 | volume= 33 | issue= 2 | pages= 157-8 | pmid=11468446 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11468446 }} </ref><ref name="pmid16911498">{{cite journal| author=Saeed SA, Integlia MJ, Pleskow RG, Calenda KA, Rohrer RJ, Dayal Y et al.| title=Tacrolimus-associated eosinophilic gastroenterocolitis in pediatric liver transplant recipients: role of potential food allergies in pathogenesis. | journal=Pediatr Transplant | year= 2006 | volume= 10 | issue= 6 | pages= 730-5 | pmid=16911498 | doi=10.1111/j.1399-3046.2006.00538.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16911498 }} </ref> | *[[Drugs]]: Some medications have been documented to cause eosinophilic infiltration of the [[GIT]]. Examples of such medications include [[gold compounds]], [[rifampicin]], [[clofazimine]], [[gemfibrozil]], [[azathioprine]], [[enalapril]], [[naproxen]] and other [[NSAIDS]], [[interferon]], [[tacrolimus]], etc.<ref name="pmid12118924">{{cite journal| author=Shakeer VK, Devi SR, Chettupuzha AP, Mustafa CP, Sandesh K, Kumar SK et al.| title=Carbamazepine-induced eosinophilic enteritis. | journal=Indian J Gastroenterol | year= 2002 | volume= 21 | issue= 3 | pages= 114-5 | pmid=12118924 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12118924 }} </ref><ref name="pmid7968003">{{cite journal| author=Lange P, Oun H, Fuller S, Turney JH| title=Eosinophilic colitis due to rifampicin. | journal=Lancet | year= 1994 | volume= 344 | issue= 8932 | pages= 1296-7 | pmid=7968003 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7968003 }} </ref><ref name="pmid16340639">{{cite journal| author=Jiménez-Sáenz M, González-Cámpora R, Linares-Santiago E, Herrerías-Gutiérrez JM| title=Bleeding colonic ulcer and eosinophilic colitis: a rare complication of nonsteroidal anti-inflammatory drugs. | journal=J Clin Gastroenterol | year= 2006 | volume= 40 | issue= 1 | pages= 84-5 | pmid=16340639 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16340639 }} </ref><ref name="pmid2220886">{{cite journal| author=Bridges AJ, Marshall JB, Diaz-Arias AA| title=Acute eosinophilic colitis and hypersensitivity reaction associated with naproxen therapy. | journal=Am J Med | year= 1990 | volume= 89 | issue= 4 | pages= 526-7 | pmid=2220886 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2220886 }} </ref><ref name="pmid10905364">{{cite journal| author=Kakumitsu S, Shijo H, Akiyoshi N, Seo M, Okada M| title=Eosinophilic enteritis observed during alpha-interferon therapy for chronic hepatitis C. | journal=J Gastroenterol | year= 2000 | volume= 35 | issue= 7 | pages= 548-51 | pmid=10905364 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10905364 }} </ref><ref name="pmid10963515">{{cite journal| author=Lee JY, Medellin MV, Tumpkin C| title=Allergic reaction to gemfibrozil manifesting as eosinophilic gastroenteritis. | journal=South Med J | year= 2000 | volume= 93 | issue= 8 | pages= 807-8 | pmid=10963515 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10963515 }} </ref><ref name="pmid8470652">{{cite journal| author=Ravi S, Holubka J, Veneri R, Youn K, Khatib R| title=Clofazimine-induced eosinophilic gastroenteritis in AIDS. | journal=Am J Gastroenterol | year= 1993 | volume= 88 | issue= 4 | pages= 612-3 | pmid=8470652 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8470652 }} </ref><ref name="pmid11468446">{{cite journal| author=Barak N, Hart J, Sitrin MD| title=Enalapril-induced eosinophilic gastroenteritis. | journal=J Clin Gastroenterol | year= 2001 | volume= 33 | issue= 2 | pages= 157-8 | pmid=11468446 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11468446 }} </ref><ref name="pmid16911498">{{cite journal| author=Saeed SA, Integlia MJ, Pleskow RG, Calenda KA, Rohrer RJ, Dayal Y et al.| title=Tacrolimus-associated eosinophilic gastroenterocolitis in pediatric liver transplant recipients: role of potential food allergies in pathogenesis. | journal=Pediatr Transplant | year= 2006 | volume= 10 | issue= 6 | pages= 730-5 | pmid=16911498 | doi=10.1111/j.1399-3046.2006.00538.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16911498 }} </ref> | ||
==Epidemiology and Demographics== | ==Epidemiology and Demographics== | ||
===Incidence=== | ===Incidence=== | ||
The estimated incidence of eosinophilic gastroenteritis is approximately 1-20 per 100,000 patients.<ref name="pmid28299223">{{cite journal| author=Shetty V, Daniel KE, Kesavan A| title=Hematemesis as Initial Presentation in a 10-Week-Old Infant with Eosinophilic Gastroenteritis. | journal=Case Rep Pediatr | year= 2017 | volume= 2017 | issue= | pages= 2391417 | pmid=28299223 | doi=10.1155/2017/2391417 | pmc=5337357 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28299223 }} </ref><ref name="pmid26054822">{{cite journal| author=Uppal V, Kreiger P, Kutsch E| title=Eosinophilic Gastroenteritis and Colitis: a Comprehensive Review. | journal=Clin Rev Allergy Immunol | year= 2016 | volume= 50 | issue= 2 | pages= 175-88 | pmid=26054822 | doi=10.1007/s12016-015-8489-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26054822 }} </ref> It is a rare disease with approximately 300 reported cases in published literature.<ref name="baig"/> | The estimated incidence of eosinophilic gastroenteritis is approximately 1-20 per 100,000 patients.<ref name="pmid28299223">{{cite journal| author=Shetty V, Daniel KE, Kesavan A| title=Hematemesis as Initial Presentation in a 10-Week-Old Infant with Eosinophilic Gastroenteritis. | journal=Case Rep Pediatr | year= 2017 | volume= 2017 | issue= | pages= 2391417 | pmid=28299223 | doi=10.1155/2017/2391417 | pmc=5337357 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28299223 }} </ref><ref name="pmid26054822">{{cite journal| author=Uppal V, Kreiger P, Kutsch E| title=Eosinophilic Gastroenteritis and Colitis: a Comprehensive Review. | journal=Clin Rev Allergy Immunol | year= 2016 | volume= 50 | issue= 2 | pages= 175-88 | pmid=26054822 | doi=10.1007/s12016-015-8489-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26054822 }} </ref> It is a rare disease with approximately 300 reported cases in published literature.<ref name="baig" /> | ||
===Age=== | ===Age=== | ||
Eosinophilic gastroenteritis can present at any age.<ref name="baig">{{cite journal| author=Baig MA, Qadir A, Rasheed J| title=A review of eosinophilic gastroenteritis. | journal=J Natl Med Assoc | year= 2006 | volume= 98 | issue= 10 | pages= 1616-9 | pmid=17052051 | doi= | pmc=2569760 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17052051 }} </ref> However, a higher incidence has been observed in the third to fifth decade of life.<ref name="pmid26054822">{{cite journal| author=Uppal V, Kreiger P, Kutsch E| title=Eosinophilic Gastroenteritis and Colitis: a Comprehensive Review. | journal=Clin Rev Allergy Immunol | year= 2016 | volume= 50 | issue= 2 | pages= 175-88 | pmid=26054822 | doi=10.1007/s12016-015-8489-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26054822 }} </ref><ref name="klein"/> In pediatric patients with eosinophilic gastroenteritis, the [[esophagus]] is usually the involved organ ([[eosinophilic esophagitis]]).<ref name="pmid28299223"/> The youngest documented pediatric case of eosinophilic gastroenteritis occurred in a full-term 10month old infant.<ref name="pmid28299223"/> | Eosinophilic gastroenteritis can present at any age.<ref name="baig">{{cite journal| author=Baig MA, Qadir A, Rasheed J| title=A review of eosinophilic gastroenteritis. | journal=J Natl Med Assoc | year= 2006 | volume= 98 | issue= 10 | pages= 1616-9 | pmid=17052051 | doi= | pmc=2569760 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17052051 }} </ref> However, a higher incidence has been observed in the third to fifth decade of life.<ref name="pmid26054822">{{cite journal| author=Uppal V, Kreiger P, Kutsch E| title=Eosinophilic Gastroenteritis and Colitis: a Comprehensive Review. | journal=Clin Rev Allergy Immunol | year= 2016 | volume= 50 | issue= 2 | pages= 175-88 | pmid=26054822 | doi=10.1007/s12016-015-8489-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26054822 }} </ref><ref name="klein" /> In pediatric patients with eosinophilic gastroenteritis, the [[esophagus]] is usually the involved organ ([[eosinophilic esophagitis]]).<ref name="pmid28299223" /> The youngest documented pediatric case of eosinophilic gastroenteritis occurred in a full-term 10month old infant.<ref name="pmid28299223" /> | ||
===Sex=== | ===Sex=== | ||
| Line 78: | Line 85: | ||
===Race=== | ===Race=== | ||
Eosinophilic gastroenteritis has been documented in all races.<ref>{{cite book | last = Guandalini | first = Stefano | title = Essential Pediatric Gastroenterology and Nutrition | publisher = McGraw-Hill Professional | location = City | year = 2004 | isbn = 0071416307 }} Page 210.</ref> However, most of the cases reported occurred in Caucasians.<ref name="baig"/> | Eosinophilic gastroenteritis has been documented in all races.<ref>{{cite book | last = Guandalini | first = Stefano | title = Essential Pediatric Gastroenterology and Nutrition | publisher = McGraw-Hill Professional | location = City | year = 2004 | isbn = 0071416307 }} Page 210.</ref> However, most of the cases reported occurred in Caucasians.<ref name="baig" /> | ||
==Screening== | ==Screening== | ||
| Line 87: | Line 94: | ||
Eosinophilic gastroenteritis is an idiopathic disease. A history of [[allergy]]/allergy-related disorders have been documented in a significant number of patients with the disease.<ref name="baig" /> | Eosinophilic gastroenteritis is an idiopathic disease. A history of [[allergy]]/allergy-related disorders have been documented in a significant number of patients with the disease.<ref name="baig" /> | ||
===Complications=== | ===Complications=== | ||
Complications of eosinophilic gastroenteritis can include the following:<ref name="talley" /><ref name="pmid15028974">{{cite journal| author=Whitaker IS, Gulati A, McDaid JO, Bugajska-Carr U, Arends MJ| title=Eosinophilic gastroenteritis presenting as obstructive jaundice. | journal=Eur J Gastroenterol Hepatol | year= 2004 | volume= 16 | issue= 4 | pages= 407-9 | pmid=15028974 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15028974 }} </ref><ref name="pmid 12757181">{{cite journal| author=Jimenez-Saenz M, Villar-Rodriguez JL, Torres Y, Carmona I, Salas-Herrero E, Gonzalez-Vilches J et al.| title=Biliary tract disease: a rare manifestation of eosinophilic gastroenteritis. | journal=Dig Dis Sci | year= 2003 | volume= 48 | issue= 3 | pages= 624-7 | pmid= 12757181 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12757181 }} </ref><ref name="pmid8420276">{{cite journal| author=Lee CM, Changchien CS, Chen PC, Lin DY, Sheen IS, Wang CS et al.| title=Eosinophilic gastroenteritis: 10 years experience. | journal=Am J Gastroenterol | year= 1993 | volume= 88 | issue= 1 | pages= 70-4 | pmid=8420276 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8420276 }} </ref><ref name="pmid26054822"/><ref name="pmid16525206">{{cite journal| author=Lyngbaek S, Adamsen S, Aru A, Bergenfeldt M| title=Recurrent acute pancreatitis due to eosinophilic gastroenteritis. Case report and literature review. | journal=JOP | year= 2006 | volume= 7 | issue= 2 | pages= 211-7 | pmid=16525206 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16525206 }} </ref> | Complications of eosinophilic gastroenteritis can include the following:<ref name="talley" /><ref name="pmid15028974">{{cite journal| author=Whitaker IS, Gulati A, McDaid JO, Bugajska-Carr U, Arends MJ| title=Eosinophilic gastroenteritis presenting as obstructive jaundice. | journal=Eur J Gastroenterol Hepatol | year= 2004 | volume= 16 | issue= 4 | pages= 407-9 | pmid=15028974 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15028974 }} </ref><ref name="pmid 12757181">{{cite journal| author=Jimenez-Saenz M, Villar-Rodriguez JL, Torres Y, Carmona I, Salas-Herrero E, Gonzalez-Vilches J et al.| title=Biliary tract disease: a rare manifestation of eosinophilic gastroenteritis. | journal=Dig Dis Sci | year= 2003 | volume= 48 | issue= 3 | pages= 624-7 | pmid= 12757181 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12757181 }} </ref><ref name="pmid8420276">{{cite journal| author=Lee CM, Changchien CS, Chen PC, Lin DY, Sheen IS, Wang CS et al.| title=Eosinophilic gastroenteritis: 10 years experience. | journal=Am J Gastroenterol | year= 1993 | volume= 88 | issue= 1 | pages= 70-4 | pmid=8420276 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8420276 }} </ref><ref name="pmid26054822" /><ref name="pmid16525206">{{cite journal| author=Lyngbaek S, Adamsen S, Aru A, Bergenfeldt M| title=Recurrent acute pancreatitis due to eosinophilic gastroenteritis. Case report and literature review. | journal=JOP | year= 2006 | volume= 7 | issue= 2 | pages= 211-7 | pmid=16525206 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16525206 }} </ref> | ||
* [[Gastric outlet obstruction]]: Pyloric outlet obstruction has been documented in patients with muscular eosinophilic gastroenteritis, and surgical intervention is often required in severe cases. | *[[Gastric outlet obstruction]]: Pyloric outlet obstruction has been documented in patients with muscular eosinophilic gastroenteritis, and surgical intervention is often required in severe cases. | ||
* Esophageal narrowing/[[strictures]]: Seen when there is esophageal involvement. | *Esophageal narrowing/[[strictures]]: Seen when there is esophageal involvement. | ||
* [[Biliary tract diseases resident survival guide|Biliary tract disease]] such as [[biliary tract]] [[fibrosis]] and [[Obstruction of bile duct|obstruction]]. | *[[Biliary tract diseases resident survival guide|Biliary tract disease]] such as [[biliary tract]] [[fibrosis]] and [[Obstruction of bile duct|obstruction]]. | ||
* [[Intestinal perforation]] | *[[Intestinal perforation]] | ||
* [[Intussusception]] | *[[Intussusception]] | ||
* [[Acute pancreatitis]] | *[[Acute pancreatitis]] | ||
===Prognosis=== | ===Prognosis=== | ||
The prognosis is good with treatment but relapses are common, which may necessitate chronic low dose steroid therapy for maintenance of remission.<ref name="pmid26054822">{{cite journal| author=Uppal V, Kreiger P, Kutsch E| title=Eosinophilic Gastroenteritis and Colitis: a Comprehensive Review. | journal=Clin Rev Allergy Immunol | year= 2016 | volume= 50 | issue= 2 | pages= 175-88 | pmid=26054822 | doi=10.1007/s12016-015-8489-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26054822 }} </ref><ref name="pmid8420276">{{cite journal| author=Lee CM, Changchien CS, Chen PC, Lin DY, Sheen IS, Wang CS et al.| title=Eosinophilic gastroenteritis: 10 years experience. | journal=Am J Gastroenterol | year= 1993 | volume= 88 | issue= 1 | pages= 70-4 | pmid=8420276 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8420276 }} </ref> If eosinophilic gastroenteritis is left untreated, patients may develop severe [[malabsorption]] and [[malnutrition]]. Spontaneous remission can also occur.<ref name="baig"/> | The prognosis is good with treatment but relapses are common, which may necessitate chronic low dose steroid therapy for maintenance of remission.<ref name="pmid26054822">{{cite journal| author=Uppal V, Kreiger P, Kutsch E| title=Eosinophilic Gastroenteritis and Colitis: a Comprehensive Review. | journal=Clin Rev Allergy Immunol | year= 2016 | volume= 50 | issue= 2 | pages= 175-88 | pmid=26054822 | doi=10.1007/s12016-015-8489-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26054822 }} </ref><ref name="pmid8420276">{{cite journal| author=Lee CM, Changchien CS, Chen PC, Lin DY, Sheen IS, Wang CS et al.| title=Eosinophilic gastroenteritis: 10 years experience. | journal=Am J Gastroenterol | year= 1993 | volume= 88 | issue= 1 | pages= 70-4 | pmid=8420276 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8420276 }} </ref> If eosinophilic gastroenteritis is left untreated, patients may develop severe [[malabsorption]] and [[malnutrition]]. Spontaneous remission can also occur.<ref name="baig" /> | ||
==Diagnosis== | ==Diagnosis== | ||
| Line 103: | Line 110: | ||
===History and Symptoms=== | ===History and Symptoms=== | ||
====History==== | ====History==== | ||
It is important to obtain the following history from the patient:<ref name="talley"/> | It is important to obtain the following history from the patient:<ref name="talley" /> | ||
* Presenting symptoms | |||
* Duration of symptoms | *Presenting symptoms | ||
* History of [[allergy]]: A history of [[food allergy]]/intolerance, [[drug allergy]], allergy-related conditions such as [[Seasonal allergy|seasonal allergies]], [[atopy]], [[asthma]], and [[nasal polyps]] should be obtained. | *Duration of symptoms | ||
*History of [[allergy]]: A history of [[food allergy]]/intolerance, [[drug allergy]], allergy-related conditions such as [[Seasonal allergy|seasonal allergies]], [[atopy]], [[asthma]], and [[nasal polyps]] should be obtained. | |||
====Symptoms==== | ====Symptoms==== | ||
Eosinophilic gastroenteritis can present with several nonspecific gastrointestinal symptoms. The manifestations often depend on the site affected in the [[Gastrointestinal tract|GIT]], and the involved layer of the gastrointestinal wall.<ref name="pmid26054822">{{cite journal| author=Uppal V, Kreiger P, Kutsch E| title=Eosinophilic Gastroenteritis and Colitis: a Comprehensive Review. | journal=Clin Rev Allergy Immunol | year= 2016 | volume= 50 | issue= 2 | pages= 175-88 | pmid=26054822 | doi=10.1007/s12016-015-8489-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26054822 }} </ref><ref name="baig">{{cite journal |author=Baig M, Qadir A, Rasheed J |title=A review of eosinophilic gastroenteritis |journal=Journal of the National Medical Association |volume=98 |issue=10 |pages=1616-9 |year=2006 |pmid=17052051}}</ref><ref name="pmid8420276">{{cite journal| author=Lee CM, Changchien CS, Chen PC, Lin DY, Sheen IS, Wang CS et al.| title=Eosinophilic gastroenteritis: 10 years experience. | journal=Am J Gastroenterol | year= 1993 | volume= 88 | issue= 1 | pages= 70-4 | pmid=8420276 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8420276 }} </ref> The following are the gastrointestinal symptoms seen in eosinophilic gastroenteritis:<ref name="talley"/><ref name="pmid 11338074"/><ref name="pmid28299223"/><ref name="baig" /><ref name="pmid8420276">{{cite journal| author=Lee CM, Changchien CS, Chen PC, Lin DY, Sheen IS, Wang CS et al.| title=Eosinophilic gastroenteritis: 10 years experience. | journal=Am J Gastroenterol | year= 1993 | volume= 88 | issue= 1 | pages= 70-4 | pmid=8420276 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8420276 }} </ref><ref name="pmid22036223">{{cite journal| author=Tien FM, Wu JF, Jeng YM, Hsu HY, Ni YH, Chang MH et al.| title=Clinical features and treatment responses of children with eosinophilic gastroenteritis. | journal=Pediatr Neonatol | year= 2011 | volume= 52 | issue= 5 | pages= 272-8 | pmid=22036223 | doi=10.1016/j.pedneo.2011.06.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22036223 }} </ref><ref name="pmid15028974">{{cite journal| author=Whitaker IS, Gulati A, McDaid JO, Bugajska-Carr U, Arends MJ| title=Eosinophilic gastroenteritis presenting as obstructive jaundice. | journal=Eur J Gastroenterol Hepatol | year= 2004 | volume= 16 | issue= 4 | pages= 407-9 | pmid=15028974 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15028974 }} </ref> | Eosinophilic gastroenteritis can present with several nonspecific gastrointestinal symptoms. The manifestations often depend on the site affected in the [[Gastrointestinal tract|GIT]], and the involved layer of the gastrointestinal wall.<ref name="pmid26054822">{{cite journal| author=Uppal V, Kreiger P, Kutsch E| title=Eosinophilic Gastroenteritis and Colitis: a Comprehensive Review. | journal=Clin Rev Allergy Immunol | year= 2016 | volume= 50 | issue= 2 | pages= 175-88 | pmid=26054822 | doi=10.1007/s12016-015-8489-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26054822 }} </ref><ref name="baig">{{cite journal |author=Baig M, Qadir A, Rasheed J |title=A review of eosinophilic gastroenteritis |journal=Journal of the National Medical Association |volume=98 |issue=10 |pages=1616-9 |year=2006 |pmid=17052051}}</ref><ref name="pmid8420276">{{cite journal| author=Lee CM, Changchien CS, Chen PC, Lin DY, Sheen IS, Wang CS et al.| title=Eosinophilic gastroenteritis: 10 years experience. | journal=Am J Gastroenterol | year= 1993 | volume= 88 | issue= 1 | pages= 70-4 | pmid=8420276 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8420276 }} </ref> The following are the gastrointestinal symptoms seen in eosinophilic gastroenteritis:<ref name="talley" /><ref name="pmid 11338074" /><ref name="pmid28299223" /><ref name="baig" /><ref name="pmid8420276">{{cite journal| author=Lee CM, Changchien CS, Chen PC, Lin DY, Sheen IS, Wang CS et al.| title=Eosinophilic gastroenteritis: 10 years experience. | journal=Am J Gastroenterol | year= 1993 | volume= 88 | issue= 1 | pages= 70-4 | pmid=8420276 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8420276 }} </ref><ref name="pmid22036223">{{cite journal| author=Tien FM, Wu JF, Jeng YM, Hsu HY, Ni YH, Chang MH et al.| title=Clinical features and treatment responses of children with eosinophilic gastroenteritis. | journal=Pediatr Neonatol | year= 2011 | volume= 52 | issue= 5 | pages= 272-8 | pmid=22036223 | doi=10.1016/j.pedneo.2011.06.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22036223 }} </ref><ref name="pmid15028974">{{cite journal| author=Whitaker IS, Gulati A, McDaid JO, Bugajska-Carr U, Arends MJ| title=Eosinophilic gastroenteritis presenting as obstructive jaundice. | journal=Eur J Gastroenterol Hepatol | year= 2004 | volume= 16 | issue= 4 | pages= 407-9 | pmid=15028974 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15028974 }} </ref> | ||
'''Common symptoms''' | '''Common symptoms''' | ||
* Episodic [[abdominal pain]] | *Episodic [[abdominal pain]] | ||
* [[Nausea]] | *[[Nausea]] | ||
* [[Vomiting]] | *[[Vomiting]] | ||
* [[Diarrhea]] | *[[Diarrhea]] | ||
* [[Poor appetite]] | *[[Poor appetite]] | ||
* [[Weight loss]] | *[[Weight loss]] | ||
* [[Steatorrhea]] | *[[Steatorrhea]] | ||
* [[Hematochezia]] | *[[Hematochezia]] | ||
* [[Bloating|Abdominal bloating]] | *[[Bloating|Abdominal bloating]] and [[ascites]]: Seen more often in patients with subserosal disease. | ||
'''Uncommon symptoms''' | '''Uncommon symptoms''' | ||
* [[Dysphagia]]: This has been documented in patients with esophageal involvement. | |||
* [[Hematemesis]] | *[[Dysphagia]]: This has been documented in patients with esophageal involvement. | ||
* [[Jaundice]] | *[[Hematemesis]] | ||
*[[Jaundice]] | |||
===Physical Examination=== | ===Physical Examination=== | ||
The physical examination findings in eosinophilic gastroenteritis are non-specific, and are mostly dependent on the site and depth of [[bowel]] involvement. The following | The physical examination findings in eosinophilic gastroenteritis are non-specific, and are mostly dependent on the site and depth of [[bowel]] involvement. The following findings may be present:<ref name="pmid26054822" /><ref name="pmid22036223">{{cite journal| author=Tien FM, Wu JF, Jeng YM, Hsu HY, Ni YH, Chang MH et al.| title=Clinical features and treatment responses of children with eosinophilic gastroenteritis. | journal=Pediatr Neonatol | year= 2011 | volume= 52 | issue= 5 | pages= 272-8 | pmid=22036223 | doi=10.1016/j.pedneo.2011.06.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22036223 }} </ref> | ||
====HEENT==== | ====HEENT==== | ||
* [[Anemia]] | |||
*[[Anemia]] | |||
====Gastrointestinal system==== | ====Gastrointestinal system==== | ||
* [[Abdominal tenderness]] | |||
* [[Ascites]] | *[[Abdominal tenderness]] | ||
* [[Hematochezia]] on rectal exam | *[[Ascites]] | ||
*[[Hematochezia]] on [[rectal exam]] | |||
====Skin==== | ====Skin==== | ||
| Line 144: | Line 156: | ||
===Laboratory Findings=== | ===Laboratory Findings=== | ||
The following laboratory findings can be seen:<ref name="talley"/><ref name="pmid26054822"/> | The following laboratory findings can be seen:<ref name="talley" /><ref name="pmid26054822" /> | ||
* [[Complete blood count|CBC]]: Peripheral blood [[eosinophilia]] is often seen, but it may be absent in >20% of affected patients. Patients with subserosal disease often have a higher eosinophil count. [[Anemia]] can also be present. | |||
* Elevated [[serum]] [[IgE]] is a common finding. | *[[Complete blood count|CBC]]: Peripheral blood [[eosinophilia]] is often seen, but it may be absent in >20% of affected patients. Patients with subserosal disease often have a higher eosinophil count. [[Anemia]] can also be present ([[iron deficiency anemia]] is a frequent finding). | ||
* Elevated [[Erythrocyte sedimentation rate|ESR]]: This can be moderately elevated in 25% of patients with eosinophilic gastroenteritis. | *Elevated [[serum]] [[IgE]] is a common finding. | ||
* [[Hypoalbuminemia]]: This can occur as a result of severe [[malabsorption]] and [[protein losing enteropathy]]. | *Elevated [[Erythrocyte sedimentation rate|ESR]]: This can be moderately elevated in 25% of patients with eosinophilic gastroenteritis. | ||
* Fecal fat test: Mild-moderate [[steatorrhea]] is sometimes seen. | *[[Hypoalbuminemia]]: This can occur as a result of severe [[malabsorption]] and [[protein losing enteropathy]]. | ||
* Stool α-1 antitrypsin clearance: For assessment of fecal protein loss. | *Fecal fat test: Mild-moderate [[steatorrhea]] is sometimes seen. | ||
* [[Allergy testing]]: Tests such as [[Skin allergy testing|skin-prick]] and [[RAST blood test|RAST]] testing may be done when specific food and environmental [[allergies]] are strongly suspected as triggers for the disease. | *Stool α-1 antitrypsin clearance: For assessment of fecal protein loss. | ||
*[[Allergy testing]]: Tests such as [[Skin allergy testing|skin-prick]] and [[RAST blood test|RAST]] testing may be done when specific food and environmental [[allergies]] are strongly suspected as triggers for the disease. | |||
===Microscopic Findings=== | ===Microscopic Findings=== | ||
Eosinophilic gastroenteritis is a diagnosis of exclusion. There are no well standardized pathologic criteria for making a diagnosis of eosinophilic gastroenteritis. There are three widely | Eosinophilic gastroenteritis is a diagnosis of exclusion. There are no well standardized pathologic criteria for making a diagnosis of eosinophilic gastroenteritis. There are three widely utilized diagnostic criteria:<ref name="pmid26054822" /><ref name="talley">{{cite journal |author=Talley N, Shorter R, Phillips S, Zinsmeister A |title=Eosinophilic gastroenteritis: a clinicopathological study of patients with disease of the mucosa, muscle layer, and subserosal tissues |journal=Gut |volume=31 |issue=1 |pages=54-8 |year=1990 |pmid=2318432}}</ref> | ||
#Presence of gastrointestinal symptoms | |||
#[[Biopsy]] demonstrating eosinophilic infiltration of one or more areas of the [[Gastrointestinal tract|GIT]] (from the [[esophagus]] to [[colon]]) | |||
#Exclusion of other causes of tissue [[eosinophilia]]. | |||
====Biopsy==== | ====Biopsy==== | ||
* Eosinophilic infiltration of the [[gastrointestinal tract]] is seen on [[histology]] following [[endoscopic]]/surgical biopsies. Abnormal eosinophilic infiltration of the [[Gastrointestinal tract|GIT]] can be defined as the presence of diffuse or multifocal [[eosinophils]] ≥20 per high power field.<ref name="talley"/><ref name="pmid26054822" /> | *[[Biopsy]] is widely used for making a diagnosis. In the absence of other causes of tissue [[eosinophilia]], eosinophilic infiltration of the [[Gastrointestinal tract|GIT]] on [[biopsy]] and/or the presence of eosinophilic [[ascitic]] fluid in a patient with gastrointestinal symptoms is diagnostic for eosinophilic gastroenteritis.<ref name="pmid28299223" /> | ||
*Eosinophilic infiltration of the [[gastrointestinal tract]] is seen on [[histology]] following [[endoscopic]]/surgical biopsies. Abnormal eosinophilic infiltration of the [[Gastrointestinal tract|GIT]] can be defined as the presence of diffuse or multifocal [[eosinophils]] ≥20 per high power field.<ref name="talley" /><ref name="pmid26054822" /> | |||
*The diagnosis can occasionally be missed, especially in patients with the localized patchy infiltration. Multiple [[biopsy]] samples throughout the [[Gastrointestinal tract|GIT]] (including visually normal areas) should be taken.<ref name="pmid26054822" /> | |||
[[File:Presentation1.jpg|center|Endoscopic [[biopsy]] of [[ileum]] showing distinct eosinophilic infiltration|1000x1000px|thumb]] | [[File:Presentation1.jpg|center|Endoscopic [[biopsy]] of [[ileum]] showing distinct eosinophilic infiltration|1000x1000px|thumb]] | ||
====Paracentesis==== | ====Paracentesis==== | ||
* In cases of suspected eosinophilic ascites, it is important to perform a diagnostic [[paracentesis]].<ref name="pmid26054822" /> | |||
*In cases of suspected eosinophilic ascites, it is important to perform a diagnostic [[paracentesis]].<ref name="pmid26054822" /> | |||
===Imaging Findings=== | ===Imaging Findings=== | ||
[[Imaging studies|Radiological studies]] are of limited diagnostic value in patients with eosinophilic gastroenteritis. The findings on imaging are often variable and non-specific. [[Imaging studies]] may reveal the following:<ref name="pmid28299223"/><ref name="chen">{{cite journal| author=Chen MJ, Chu CH, Lin SC, Shih SC, Wang TE| title=Eosinophilic gastroenteritis: clinical experience with 15 patients. | journal=World J Gastroenterol | year= 2003 | volume= 9 | issue= 12 | pages= 2813-6 | pmid=14669340 | doi= | pmc=4612059 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14669340 }} </ref><ref name="talley"/><ref name="pmid14651361">{{cite journal| author=Imai E, Kaminaga T, Kawasugi K, Yokokawa T, Furui S| title=The usefulness of 99mTc-hexamethylpropyleneamineoxime white blood cell scintigraphy in a patient with eosinophilic gastroenteritis. | journal=Ann Nucl Med | year= 2003 | volume= 17 | issue= 7 | pages= 601-3 | pmid=14651361 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14651361 }} </ref><ref name="pmid9262899">{{cite journal| author=Lee KJ, Hahm KB, Kim YS, Kim JH, Cho SW, Jie H et al.| title=The usefulness of Tc-99m HMPAO labeled WBC SPECT in eosinophilic gastroenteritis. | journal=Clin Nucl Med | year= 1997 | volume= 22 | issue= 8 | pages= 536-41 | pmid=9262899 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9262899 }} </ref> | [[Imaging studies|Radiological studies]] are of limited diagnostic value in patients with eosinophilic gastroenteritis. The findings on imaging are often variable and non-specific. [[Imaging studies]] may reveal the following:<ref name="pmid28299223" /><ref name="chen">{{cite journal| author=Chen MJ, Chu CH, Lin SC, Shih SC, Wang TE| title=Eosinophilic gastroenteritis: clinical experience with 15 patients. | journal=World J Gastroenterol | year= 2003 | volume= 9 | issue= 12 | pages= 2813-6 | pmid=14669340 | doi= | pmc=4612059 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14669340 }} </ref><ref name="talley" /><ref name="pmid14651361">{{cite journal| author=Imai E, Kaminaga T, Kawasugi K, Yokokawa T, Furui S| title=The usefulness of 99mTc-hexamethylpropyleneamineoxime white blood cell scintigraphy in a patient with eosinophilic gastroenteritis. | journal=Ann Nucl Med | year= 2003 | volume= 17 | issue= 7 | pages= 601-3 | pmid=14651361 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14651361 }} </ref><ref name="pmid9262899">{{cite journal| author=Lee KJ, Hahm KB, Kim YS, Kim JH, Cho SW, Jie H et al.| title=The usefulness of Tc-99m HMPAO labeled WBC SPECT in eosinophilic gastroenteritis. | journal=Clin Nucl Med | year= 1997 | volume= 22 | issue= 8 | pages= 536-41 | pmid=9262899 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9262899 }} </ref> | ||
====Ultrasonography==== | ====Ultrasonography==== | ||
* Presence of [[Bowel|bowe]]<nowiki/>l thickening/folds, [[ascites]] and [[peritoneal]] nodules. | |||
* Response to therapy | *Presence of [[Bowel|bowe]]<nowiki/>l thickening/folds, [[ascites]] and [[peritoneal]] nodules. | ||
*Response to therapy | |||
====CT scan==== | ====CT scan==== | ||
* Prominent nodular, irregular folds/thickening of the [[stomach]] and [[intestines]] (similar findings can be seen in other diseases such as [[Crohn's disease|Crohn’s disease]] and [[lymphoma]]). | |||
* [[Ascites]] | *Prominent nodular, irregular folds/thickening of the [[stomach]] and [[intestines]] (similar findings can be seen in other diseases such as [[Crohn's disease|Crohn’s disease]] and [[lymphoma]]). | ||
*[[Ascites]] | |||
====Barium studies==== | ====Barium studies==== | ||
* Antral stenosis and mucosal irregularity of the [[stomach]]. A [[string sign]] appearance can be seen on [[Barium|barium studies]] when complications such as [[gastric outlet obstruction]] occur. | |||
* Thickened mucosal folds of the [[small intestine]] due to [[edema]]. | *Antral stenosis and mucosal irregularity of the [[stomach]]. A [[string sign]] appearance can be seen on [[Barium|barium studies]] when complications such as [[gastric outlet obstruction]] occur. | ||
*Thickened mucosal folds of the [[small intestine]] due to [[edema]]. | |||
====Endoscopy==== | ====Endoscopy==== | ||
* Normal appearance of the [[Gastrointestinal tract|GIT]]. | |||
* Gross findings such as gastric [[pseudopolyps]]. | *Normal appearance of the [[Gastrointestinal tract|GIT]]. | ||
* Other non-specific findings such as mucosal [[erythema]], friability, and fine [[granularity]] in the [[stomach]] may be seen. Mucosal [[ulcerations]]/erosions, thickening of gastric mucosal folds and mucosal nodules or whitish specks are sometimes seen. | *Gross findings such as gastric [[pseudopolyps]]. | ||
*Other non-specific findings such as mucosal [[erythema]], friability, and fine [[granularity]] in the [[stomach]] may be seen. Mucosal [[ulcerations]]/erosions, thickening of gastric mucosal folds and mucosal nodules or whitish specks are sometimes seen. | |||
====Tc-99m hexamethylpropyleneamine oxime(HMPAO) scintigraphy scanning==== | ====Tc-99m hexamethylpropyleneamine oxime(HMPAO) scintigraphy scanning==== | ||
* Radionuclide scan using [[Tc-99m]] HMPAO-labeled [[leukocyte]] [[single photon emission computed tomography|SPECT]] may be useful for assessing the extent of disease and the response to treatment | |||
* It cannot differentiate eosinophilic gastroenteritis from other causes of [[Gastrointestinal tract|GIT]] [[inflammation]], hence, it is not a diagnostic test. | *Radionuclide scan using [[Tc-99m]] HMPAO-labeled [[leukocyte]] [[single photon emission computed tomography|SPECT]] may be useful for assessing the extent of disease and the response to treatment | ||
*It cannot differentiate eosinophilic gastroenteritis from other causes of [[Gastrointestinal tract|GIT]] [[inflammation]], hence, it is not a diagnostic test. | |||
==Treatment== | ==Treatment== | ||
There | There is no guidelines/definitive consensus for the management of eosinophilic gastroenteritis, and the treatment is usually based on the severity of the disease. [[Steroids]] are widely recognized as the mainstay of treatment for eosinophilic gastroenteritis. Chronic [[Relapse|relapses]] frequently occur and continued maintenance on low dose [[steroid]] therapy may be necessary.<ref name="pmid26054822">{{cite journal| author=Uppal V, Kreiger P, Kutsch E| title=Eosinophilic Gastroenteritis and Colitis: a Comprehensive Review. | journal=Clin Rev Allergy Immunol | year= 2016 | volume= 50 | issue= 2 | pages= 175-88 | pmid=26054822 | doi=10.1007/s12016-015-8489-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26054822 }} </ref><ref name="pmid8420276">{{cite journal| author=Lee CM, Changchien CS, Chen PC, Lin DY, Sheen IS, Wang CS et al.| title=Eosinophilic gastroenteritis: 10 years experience. | journal=Am J Gastroenterol | year= 1993 | volume= 88 | issue= 1 | pages= 70-4 | pmid=8420276 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8420276 }} </ref> | ||
===Medical Therapy=== | ===Medical Therapy=== | ||
The medical management of eosinophilic gastroenteritis entails the following:<ref name="talley"/><ref name="pmid26054822" /><ref name="pmid6547462">{{cite journal| author=Katz AJ, Twarog FJ, Zeiger RS, Falchuk ZM| title=Milk-sensitive and eosinophilic gastroenteropathy: similar clinical features with contrasting mechanisms and clinical course. | journal=J Allergy Clin Immunol | year= 1984 | volume= 74 | issue= 1 | pages= 72-8 | pmid=6547462 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6547462 }} </ref><ref name="chen"/><ref name="pmid28299223" /><ref name="pmid28279648">{{cite journal| author=Yanagimoto Y, Taniuchi S, Ishizaki Y, Nakano K, Hosaka N, Kaneko K| title=Eosinophilic gastroenteritis caused by eating hens' eggs: A case report. | journal=Allergol Int | year= 2017 | volume= | issue= | pages= | pmid=28279648 | doi=10.1016/j.alit.2017.02.007 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28279648 }} </ref> | The medical management of eosinophilic gastroenteritis entails the following:<ref name="talley" /><ref name="pmid26054822" /><ref name="pmid6547462">{{cite journal| author=Katz AJ, Twarog FJ, Zeiger RS, Falchuk ZM| title=Milk-sensitive and eosinophilic gastroenteropathy: similar clinical features with contrasting mechanisms and clinical course. | journal=J Allergy Clin Immunol | year= 1984 | volume= 74 | issue= 1 | pages= 72-8 | pmid=6547462 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6547462 }} </ref><ref name="chen" /><ref name="pmid28299223" /><ref name="pmid28279648">{{cite journal| author=Yanagimoto Y, Taniuchi S, Ishizaki Y, Nakano K, Hosaka N, Kaneko K| title=Eosinophilic gastroenteritis caused by eating hens' eggs: A case report. | journal=Allergol Int | year= 2017 | volume= | issue= | pages= | pmid=28279648 | doi=10.1016/j.alit.2017.02.007 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28279648 }} </ref> | ||
'''Preferred therapy''' | '''Preferred therapy''' | ||
* [[Corticosteroids]]: This is the mainstay of therapy for eosinophilic gastroenteritis. A dramatic response to [[Corticosteroid medications|corticosteroid therapy]] is commonly seen in patients with subserosal disease. A 90% response rate to [[Corticosteroid medications|corticosteroid therapy]] has been documented in some studies. | |||
* Dietary modification | *[[Corticosteroids]]: This is the mainstay of therapy for eosinophilic gastroenteritis. A dramatic response to [[Corticosteroid medications|corticosteroid therapy]] is commonly seen in patients with subserosal disease. A 90% response rate to [[Corticosteroid medications|corticosteroid therapy]] has been documented in some studies. | ||
# Elimination of identified food [[allergies]] from the diet. | *Dietary modification | ||
# Introduction of elemental diets. | |||
#Elimination of identified food [[allergies]] from the diet. | |||
#Introduction of elemental diets. | |||
'''Alternate therapy''' | '''Alternate therapy''' | ||
| Line 208: | Line 232: | ||
These medications can be used alone or in combination with [[steroids]] for treatment and/or maintenance therapy. | These medications can be used alone or in combination with [[steroids]] for treatment and/or maintenance therapy. | ||
* [[Ketotifen]] | *[[Ketotifen]] | ||
* [[Cromolyn|Cromolyn sodium]] | *[[Cromolyn|Cromolyn sodium]] | ||
* [[Montelukast]]: Either used alone or in combination with steroids as a steroid-sparing agent. Some patients treated with montelukast alone did not have a relapse.<ref name="pmid22036223">{{cite journal| author=Tien FM, Wu JF, Jeng YM, Hsu HY, Ni YH, Chang MH et al.| title=Clinical features and treatment responses of children with eosinophilic gastroenteritis. | journal=Pediatr Neonatol | year= 2011 | volume= 52 | issue= 5 | pages= 272-8 | pmid=22036223 | doi=10.1016/j.pedneo.2011.06.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22036223 }} </ref> | *[[Montelukast]]: Either used alone or in combination with steroids as a steroid-sparing agent. Some patients treated with montelukast alone did not have a relapse.<ref name="pmid22036223">{{cite journal| author=Tien FM, Wu JF, Jeng YM, Hsu HY, Ni YH, Chang MH et al.| title=Clinical features and treatment responses of children with eosinophilic gastroenteritis. | journal=Pediatr Neonatol | year= 2011 | volume= 52 | issue= 5 | pages= 272-8 | pmid=22036223 | doi=10.1016/j.pedneo.2011.06.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22036223 }} </ref> | ||
* Suplatast tosilate<ref name="pmid11344364">{{cite journal| author=Shirai T, Hashimoto D, Suzuki K, Osawa S, Aonahata M, Chida K et al.| title=Successful treatment of eosinophilic gastroenteritis with suplatast tosilate. | journal=J Allergy Clin Immunol | year= 2001 | volume= 107 | issue= 5 | pages= 924-5 | pmid=11344364 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11344364 }} </ref> | *Suplatast tosilate<ref name="pmid11344364">{{cite journal| author=Shirai T, Hashimoto D, Suzuki K, Osawa S, Aonahata M, Chida K et al.| title=Successful treatment of eosinophilic gastroenteritis with suplatast tosilate. | journal=J Allergy Clin Immunol | year= 2001 | volume= 107 | issue= 5 | pages= 924-5 | pmid=11344364 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11344364 }} </ref> | ||
* Biologic medications such as [[omalizumab]], [[reslizumab]] and [[mepolizumab]]. | *Biologic medications such as [[omalizumab]], [[reslizumab]], and [[mepolizumab]]. | ||
===Surgical Therapy=== | ===Surgical Therapy=== | ||
There are no indications for surgery in the primary management of eosinophilic gastroenteritis. However, surgical management may be required when complications such as intestinal perforation or severe [[gastric outlet obstruction]] | There are no indications for surgery in the primary management of eosinophilic gastroenteritis. However, surgical management may be required when complications such as intestinal perforation or severe [[gastric outlet obstruction]] occur. | ||
===Prevention=== | ===Prevention=== | ||
Latest revision as of 12:32, 1 January 2021
| Eosinophilic gastroenteritis | |
 | |
|---|---|
| H&E Stain: Dense Eosinophilic infiltration of gastro-duodenal wall | |
| ICD-10 | K52.8 |
| ICD-9 | 558.3 |
| DiseasesDB | 32555 |
| eMedicine | med/688 |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Fatimo Biobaku M.B.B.S [2]
Synonyms and keywords: Eosinophilic esophagitis; eosinophilic gastritis; Eosinophilic enteritis; Eosinophilic colitis; Eosinophilic proctocolitis, Eosinophilic gastrointestinal disorders
Overview
Eosinophilic gastroenteritis is a rare, heterogenous disorder characterized by localized patchy or diffuse eosinophilic infiltration of the gastrointestinal tract.[1] Most of the data available in the literature are based on few documented case reports/case series. The presentation of eosinophilic gastroenteritis may vary depending on the location, depth and extent of bowel wall involvement.[2][1][3] The cause of eosinophilic gastroenteritis is idiopathic although there is a significant association with allergy.[2][1] Non-specific gastrointestinal symptoms such as episodic abdominal pain, vomiting and diarrhea are common. Eosinophilic gastroenteritis is a diagnosis of exclusion and other causes of GIT symptoms with gastrointestinal tissue eosinophilia must be ruled out.[2] Biopsy of the GIT is the primary diagnostic modality. The mainstay of treatment is corticosteroid therapy. Majority of patients respond well to treatment but the disease may run a chronic relapsing course.[4][2]
Historical Perspective
The first description of eosinophilic gastroenteritis was by Kaijser et al. in 1937, and it was described as an allergic disease of the gut.[5][6] Klein et al. subsequently classified it into three types (predominant mucosal, muscular, and subserosal layer disease) based on the depth of eosinophilic infiltration.[7]
Classification
Eosinophilic gastroenteritis can be subdivided into three groups according to the Klein classification:[4][8][1][3][2]
- Mucosal eosinophilic gastroenteritis
- Most common subtype of eosinophilic gastroenteritis.
- Mucosal infiltration by eosinophils, and/or presence of mucosal edema on barium studies.
- Absent histological evidence of muscle infiltration.
- No evidence of gastrointestinal obstruction or eosinophilic ascites.
- Muscular eosinophilic gastroenteritis
- Documentation of complete/incomplete bowel obstruction, and/or infiltration of the tunica muscularis by eosinophils.
- No evidence of eosinophilic ascites.
- Subserosal eosinophilic gastroenteritis
- Eosinophilic infiltration of the gut
- Presence of eosinophilic ascites (may occasionally progress to an eosinophilic pleural effusion)
Causes
The cause of eosinophilic gastroenteritis is unknown.[1]
Risk Factors
- Allergy: A study conducted in 40 patients with eosinophilic gastroenteritis demonstrated a history of allergy in half of the patients.[8] Food intolerance or allergy is more commonly seen in mucosal eosinophilic gastroenteritis, affecting over 50% of patients with mucosal disease according to a study.[8]
Pathophysiology
Pathogenesis
- Eosinophilic gastroenteritis is a rare disease with poorly understood pathophysiology.
- Eosinophils are normally seen in the entire GIT (except in the esophagus) of healthy individuals.[2]
- In patients with eosinophilic gastroenteritis, there is varying degrees of increased eosinophilic infiltration of the GIT (in the absence of other known causes of tissue eosinophilia).[6][2]
- Any part of the GIT from the esophagus to the colon can be affected. Occasionally, eosinophilic gastroenteritis affects the entire gastrointestinal tract.[8] The stomach and proximal small intestine are most commonly affected, while the colon is usually the least affected part of the GIT.[6][8][2]
- The etiology of the excessive eosinophilic infiltration of the GIT is not clear. Destruction of the GIT epithelium caused by the release of eosinophilic basic protein and activated degranulating eosinophils has been proposed.[8][9]
- Inflammatory mediators such as Th-2 cytokines (IL-3, IL-5, GM-CSF and IL-13), monocyte generating chemokines such as IL-8, monocyte chemotactic proteins, mast cells, granulocytes, eosinophils, and eosinophilic mediators such as eotaxin have been strongly implicated.[6][2][1]
- The inflammatory mediators associated with the pathogenesis of eosinophilic gastroenteritis have well established roles in the pathogenesis of allergy and asthma. A significant number of patients with eosinophilic gastroenteritis have also been documented to have allergies/allergy-related disorders, suggesting a hypersensitivity reaction is involved in the pathogenesis of eosinophilic gastroenteritis.[6][1]
Differentiating Eosinophilic gastroenteritis from Other Diseases
Diseases with peripheral eosinophilia and gastrointestinal symptoms should be differentiated from eosinophilic gastroenteritis. It is also important to consider eosinophilic gastroenteritis in the differential diagnosis of unexplained gastrointestinal symptoms (even when peripheral eosinophilia is not present). Most diseases that can manifest with gastrointestinal symptoms and peripheral eosinophilia are easily differentiated from eosinophilic gastroenteritis via detailed history taking, laboratory investigations, and histologic examination of endoscopic biopsies.[1][2] Some of these diseases include:[1][2][10][11]
- Intestinal parasitic infections: Stool examination for ova and parasites can be utilized for diagnosis.
- Inflammatory bowel disease (IBD): Biopsy can easily distinguish IBD from eosinophilic gastroenteritis.
- Hypereosinophilic syndrome: It usually presents with markedly elevated peripheral eosinophilia (>1500 cells/μL) for more than six consecutive months. Eosinophilic gastroenteritis is observed in association with eosinophilic infiltration of other organ systems. The organs that are commonly affected in hypereosinophilic syndrome are the lungs, skin, GIT, kidneys, heart and brain.
- Helicobacter pylori infecton: This is not a common cause of tissue eosinophilia. Histology of gastric biopsies using silver staining can rule out Helicobacter pylori infection.
- Vasculitic disorders such as churg-strauss syndrome and polyarteritis nodosa: Eosinophilic infiltration of small blood vessels in the GIT is seen. Autoantibodies are usually present and markers of inflammation are elevated.
- Connective tissue disorders such as scleroderma, polymyositis, dermatomyositis, systemic lupus erythematosus.
- Celiac disease: Serology and biopsy can differentiate it from eosinophilic gastroenteritis.
- Drugs: Some medications have been documented to cause eosinophilic infiltration of the GIT. Examples of such medications include gold compounds, rifampicin, clofazimine, gemfibrozil, azathioprine, enalapril, naproxen and other NSAIDS, interferon, tacrolimus, etc.[12][13][14][15][16][17][18][19][20]
Epidemiology and Demographics
Incidence
The estimated incidence of eosinophilic gastroenteritis is approximately 1-20 per 100,000 patients.[6][2] It is a rare disease with approximately 300 reported cases in published literature.[1]
Age
Eosinophilic gastroenteritis can present at any age.[1] However, a higher incidence has been observed in the third to fifth decade of life.[2][4] In pediatric patients with eosinophilic gastroenteritis, the esophagus is usually the involved organ (eosinophilic esophagitis).[6] The youngest documented pediatric case of eosinophilic gastroenteritis occurred in a full-term 10month old infant.[6]
Sex
There is a slightly higher incidence in adult males.[1]
Race
Eosinophilic gastroenteritis has been documented in all races.[21] However, most of the cases reported occurred in Caucasians.[1]
Screening
There is no screening guideline for eosinophilic gastroenteritis.
Natural History, Complications, and Prognosis
Natural History
Eosinophilic gastroenteritis is an idiopathic disease. A history of allergy/allergy-related disorders have been documented in a significant number of patients with the disease.[1]
Complications
Complications of eosinophilic gastroenteritis can include the following:[8][5][22][3][2][23]
- Gastric outlet obstruction: Pyloric outlet obstruction has been documented in patients with muscular eosinophilic gastroenteritis, and surgical intervention is often required in severe cases.
- Esophageal narrowing/strictures: Seen when there is esophageal involvement.
- Biliary tract disease such as biliary tract fibrosis and obstruction.
- Intestinal perforation
- Intussusception
- Acute pancreatitis
Prognosis
The prognosis is good with treatment but relapses are common, which may necessitate chronic low dose steroid therapy for maintenance of remission.[2][3] If eosinophilic gastroenteritis is left untreated, patients may develop severe malabsorption and malnutrition. Spontaneous remission can also occur.[1]
Diagnosis
History and Symptoms
History
It is important to obtain the following history from the patient:[8]
- Presenting symptoms
- Duration of symptoms
- History of allergy: A history of food allergy/intolerance, drug allergy, allergy-related conditions such as seasonal allergies, atopy, asthma, and nasal polyps should be obtained.
Symptoms
Eosinophilic gastroenteritis can present with several nonspecific gastrointestinal symptoms. The manifestations often depend on the site affected in the GIT, and the involved layer of the gastrointestinal wall.[2][1][3] The following are the gastrointestinal symptoms seen in eosinophilic gastroenteritis:[8][9][6][1][3][24][5]
Common symptoms
- Episodic abdominal pain
- Nausea
- Vomiting
- Diarrhea
- Poor appetite
- Weight loss
- Steatorrhea
- Hematochezia
- Abdominal bloating and ascites: Seen more often in patients with subserosal disease.
Uncommon symptoms
- Dysphagia: This has been documented in patients with esophageal involvement.
- Hematemesis
- Jaundice
Physical Examination
The physical examination findings in eosinophilic gastroenteritis are non-specific, and are mostly dependent on the site and depth of bowel involvement. The following findings may be present:[2][24]
HEENT
Gastrointestinal system
Skin
Eczema may be seen in patients with atopy.
Laboratory Findings
The following laboratory findings can be seen:[8][2]
- CBC: Peripheral blood eosinophilia is often seen, but it may be absent in >20% of affected patients. Patients with subserosal disease often have a higher eosinophil count. Anemia can also be present (iron deficiency anemia is a frequent finding).
- Elevated serum IgE is a common finding.
- Elevated ESR: This can be moderately elevated in 25% of patients with eosinophilic gastroenteritis.
- Hypoalbuminemia: This can occur as a result of severe malabsorption and protein losing enteropathy.
- Fecal fat test: Mild-moderate steatorrhea is sometimes seen.
- Stool α-1 antitrypsin clearance: For assessment of fecal protein loss.
- Allergy testing: Tests such as skin-prick and RAST testing may be done when specific food and environmental allergies are strongly suspected as triggers for the disease.
Microscopic Findings
Eosinophilic gastroenteritis is a diagnosis of exclusion. There are no well standardized pathologic criteria for making a diagnosis of eosinophilic gastroenteritis. There are three widely utilized diagnostic criteria:[2][8]
- Presence of gastrointestinal symptoms
- Biopsy demonstrating eosinophilic infiltration of one or more areas of the GIT (from the esophagus to colon)
- Exclusion of other causes of tissue eosinophilia.
Biopsy
- Biopsy is widely used for making a diagnosis. In the absence of other causes of tissue eosinophilia, eosinophilic infiltration of the GIT on biopsy and/or the presence of eosinophilic ascitic fluid in a patient with gastrointestinal symptoms is diagnostic for eosinophilic gastroenteritis.[6]
- Eosinophilic infiltration of the gastrointestinal tract is seen on histology following endoscopic/surgical biopsies. Abnormal eosinophilic infiltration of the GIT can be defined as the presence of diffuse or multifocal eosinophils ≥20 per high power field.[8][2]
- The diagnosis can occasionally be missed, especially in patients with the localized patchy infiltration. Multiple biopsy samples throughout the GIT (including visually normal areas) should be taken.[2]
Paracentesis
- In cases of suspected eosinophilic ascites, it is important to perform a diagnostic paracentesis.[2]
Imaging Findings
Radiological studies are of limited diagnostic value in patients with eosinophilic gastroenteritis. The findings on imaging are often variable and non-specific. Imaging studies may reveal the following:[6][25][8][26][27]
Ultrasonography
- Presence of bowel thickening/folds, ascites and peritoneal nodules.
- Response to therapy
CT scan
- Prominent nodular, irregular folds/thickening of the stomach and intestines (similar findings can be seen in other diseases such as Crohn’s disease and lymphoma).
- Ascites
Barium studies
- Antral stenosis and mucosal irregularity of the stomach. A string sign appearance can be seen on barium studies when complications such as gastric outlet obstruction occur.
- Thickened mucosal folds of the small intestine due to edema.
Endoscopy
- Normal appearance of the GIT.
- Gross findings such as gastric pseudopolyps.
- Other non-specific findings such as mucosal erythema, friability, and fine granularity in the stomach may be seen. Mucosal ulcerations/erosions, thickening of gastric mucosal folds and mucosal nodules or whitish specks are sometimes seen.
Tc-99m hexamethylpropyleneamine oxime(HMPAO) scintigraphy scanning
- Radionuclide scan using Tc-99m HMPAO-labeled leukocyte SPECT may be useful for assessing the extent of disease and the response to treatment
- It cannot differentiate eosinophilic gastroenteritis from other causes of GIT inflammation, hence, it is not a diagnostic test.
Treatment
There is no guidelines/definitive consensus for the management of eosinophilic gastroenteritis, and the treatment is usually based on the severity of the disease. Steroids are widely recognized as the mainstay of treatment for eosinophilic gastroenteritis. Chronic relapses frequently occur and continued maintenance on low dose steroid therapy may be necessary.[2][3]
Medical Therapy
The medical management of eosinophilic gastroenteritis entails the following:[8][2][28][25][6][29]
Preferred therapy
- Corticosteroids: This is the mainstay of therapy for eosinophilic gastroenteritis. A dramatic response to corticosteroid therapy is commonly seen in patients with subserosal disease. A 90% response rate to corticosteroid therapy has been documented in some studies.
- Dietary modification
- Elimination of identified food allergies from the diet.
- Introduction of elemental diets.
Alternate therapy
These medications can be used alone or in combination with steroids for treatment and/or maintenance therapy.
- Ketotifen
- Cromolyn sodium
- Montelukast: Either used alone or in combination with steroids as a steroid-sparing agent. Some patients treated with montelukast alone did not have a relapse.[24]
- Suplatast tosilate[30]
- Biologic medications such as omalizumab, reslizumab, and mepolizumab.
Surgical Therapy
There are no indications for surgery in the primary management of eosinophilic gastroenteritis. However, surgical management may be required when complications such as intestinal perforation or severe gastric outlet obstruction occur.
Prevention
There are no guidelines for the prevention of eosinophilic gastroenteritis. Elimination of identified triggers such as food allergies may be beneficial.[29]
References
- ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 1.15 1.16 Baig MA, Qadir A, Rasheed J (2006). "A review of eosinophilic gastroenteritis". J Natl Med Assoc. 98 (10): 1616–9. PMC 2569760. PMID 17052051.
- ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 2.14 2.15 2.16 2.17 2.18 2.19 2.20 2.21 2.22 2.23 Uppal V, Kreiger P, Kutsch E (2016). "Eosinophilic Gastroenteritis and Colitis: a Comprehensive Review". Clin Rev Allergy Immunol. 50 (2): 175–88. doi:10.1007/s12016-015-8489-4. PMID 26054822.
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 Lee CM, Changchien CS, Chen PC, Lin DY, Sheen IS, Wang CS; et al. (1993). "Eosinophilic gastroenteritis: 10 years experience". Am J Gastroenterol. 88 (1): 70–4. PMID 8420276.
- ↑ 4.0 4.1 4.2 Klein NC, Hargrove RL, Sleisenger MH, Jeffries GH (1970). "Eosinophilic gastroenteritis". Medicine (Baltimore). 49 (4): 299–319. PMID 5426746.
- ↑ 5.0 5.1 5.2 Whitaker IS, Gulati A, McDaid JO, Bugajska-Carr U, Arends MJ (2004). "Eosinophilic gastroenteritis presenting as obstructive jaundice". Eur J Gastroenterol Hepatol. 16 (4): 407–9. PMID 15028974.
- ↑ 6.00 6.01 6.02 6.03 6.04 6.05 6.06 6.07 6.08 6.09 6.10 6.11 Shetty V, Daniel KE, Kesavan A (2017). "Hematemesis as Initial Presentation in a 10-Week-Old Infant with Eosinophilic Gastroenteritis". Case Rep Pediatr. 2017: 2391417. doi:10.1155/2017/2391417. PMC 5337357. PMID 28299223.
- ↑ Klein NC, Hargrove RL, Sleisenger MH, Jeffries GH (1970). "Eosinophilic gastroenteritis". Medicine (Baltimore). 49 (4): 299–319. PMID 5426746.
- ↑ 8.00 8.01 8.02 8.03 8.04 8.05 8.06 8.07 8.08 8.09 8.10 8.11 8.12 8.13 Talley NJ, Shorter RG, Phillips SF, Zinsmeister AR (1990). "Eosinophilic gastroenteritis: a clinicopathological study of patients with disease of the mucosa, muscle layer, and subserosal tissues". Gut. 31 (1): 54–8. PMC 1378340. PMID 2318432 2318432 Check
|pmid=value (help). - ↑ 9.0 9.1 Tan AC, Kruimel JW, Naber TH (2001). "Eosinophilic gastroenteritis treated with non-enteric-coated budesonide tablets". Eur J Gastroenterol Hepatol. 13 (4): 425–7. PMID 11338074 11338074 Check
|pmid=value (help). - ↑ Matsushita M, Hajiro K, Morita Y, Takakuwa H, Suzaki T (1995). "Eosinophilic gastroenteritis involving the entire digestive tract". Am J Gastroenterol. 90 (10): 1868–70. PMID 7572911.
- ↑ Barbie DA, Mangi AA, Lauwers GY (2004). "Eosinophilic gastroenteritis associated with systemic lupus erythematosus". J Clin Gastroenterol. 38 (10): 883–6. PMID 15492606.
- ↑ Shakeer VK, Devi SR, Chettupuzha AP, Mustafa CP, Sandesh K, Kumar SK; et al. (2002). "Carbamazepine-induced eosinophilic enteritis". Indian J Gastroenterol. 21 (3): 114–5. PMID 12118924.
- ↑ Lange P, Oun H, Fuller S, Turney JH (1994). "Eosinophilic colitis due to rifampicin". Lancet. 344 (8932): 1296–7. PMID 7968003.
- ↑ Jiménez-Sáenz M, González-Cámpora R, Linares-Santiago E, Herrerías-Gutiérrez JM (2006). "Bleeding colonic ulcer and eosinophilic colitis: a rare complication of nonsteroidal anti-inflammatory drugs". J Clin Gastroenterol. 40 (1): 84–5. PMID 16340639.
- ↑ Bridges AJ, Marshall JB, Diaz-Arias AA (1990). "Acute eosinophilic colitis and hypersensitivity reaction associated with naproxen therapy". Am J Med. 89 (4): 526–7. PMID 2220886.
- ↑ Kakumitsu S, Shijo H, Akiyoshi N, Seo M, Okada M (2000). "Eosinophilic enteritis observed during alpha-interferon therapy for chronic hepatitis C." J Gastroenterol. 35 (7): 548–51. PMID 10905364.
- ↑ Lee JY, Medellin MV, Tumpkin C (2000). "Allergic reaction to gemfibrozil manifesting as eosinophilic gastroenteritis". South Med J. 93 (8): 807–8. PMID 10963515.
- ↑ Ravi S, Holubka J, Veneri R, Youn K, Khatib R (1993). "Clofazimine-induced eosinophilic gastroenteritis in AIDS". Am J Gastroenterol. 88 (4): 612–3. PMID 8470652.
- ↑ Barak N, Hart J, Sitrin MD (2001). "Enalapril-induced eosinophilic gastroenteritis". J Clin Gastroenterol. 33 (2): 157–8. PMID 11468446.
- ↑ Saeed SA, Integlia MJ, Pleskow RG, Calenda KA, Rohrer RJ, Dayal Y; et al. (2006). "Tacrolimus-associated eosinophilic gastroenterocolitis in pediatric liver transplant recipients: role of potential food allergies in pathogenesis". Pediatr Transplant. 10 (6): 730–5. doi:10.1111/j.1399-3046.2006.00538.x. PMID 16911498.
- ↑ Guandalini, Stefano (2004). Essential Pediatric Gastroenterology and Nutrition. City: McGraw-Hill Professional. ISBN 0071416307. Page 210.
- ↑ Jimenez-Saenz M, Villar-Rodriguez JL, Torres Y, Carmona I, Salas-Herrero E, Gonzalez-Vilches J; et al. (2003). "Biliary tract disease: a rare manifestation of eosinophilic gastroenteritis". Dig Dis Sci. 48 (3): 624–7. PMID 12757181 12757181 Check
|pmid=value (help). - ↑ Lyngbaek S, Adamsen S, Aru A, Bergenfeldt M (2006). "Recurrent acute pancreatitis due to eosinophilic gastroenteritis. Case report and literature review". JOP. 7 (2): 211–7. PMID 16525206.
- ↑ 24.0 24.1 24.2 Tien FM, Wu JF, Jeng YM, Hsu HY, Ni YH, Chang MH; et al. (2011). "Clinical features and treatment responses of children with eosinophilic gastroenteritis". Pediatr Neonatol. 52 (5): 272–8. doi:10.1016/j.pedneo.2011.06.006. PMID 22036223.
- ↑ 25.0 25.1 Chen MJ, Chu CH, Lin SC, Shih SC, Wang TE (2003). "Eosinophilic gastroenteritis: clinical experience with 15 patients". World J Gastroenterol. 9 (12): 2813–6. PMC 4612059. PMID 14669340.
- ↑ Imai E, Kaminaga T, Kawasugi K, Yokokawa T, Furui S (2003). "The usefulness of 99mTc-hexamethylpropyleneamineoxime white blood cell scintigraphy in a patient with eosinophilic gastroenteritis". Ann Nucl Med. 17 (7): 601–3. PMID 14651361.
- ↑ Lee KJ, Hahm KB, Kim YS, Kim JH, Cho SW, Jie H; et al. (1997). "The usefulness of Tc-99m HMPAO labeled WBC SPECT in eosinophilic gastroenteritis". Clin Nucl Med. 22 (8): 536–41. PMID 9262899.
- ↑ Katz AJ, Twarog FJ, Zeiger RS, Falchuk ZM (1984). "Milk-sensitive and eosinophilic gastroenteropathy: similar clinical features with contrasting mechanisms and clinical course". J Allergy Clin Immunol. 74 (1): 72–8. PMID 6547462.
- ↑ 29.0 29.1 Yanagimoto Y, Taniuchi S, Ishizaki Y, Nakano K, Hosaka N, Kaneko K (2017). "Eosinophilic gastroenteritis caused by eating hens' eggs: A case report". Allergol Int. doi:10.1016/j.alit.2017.02.007. PMID 28279648.
- ↑ Shirai T, Hashimoto D, Suzuki K, Osawa S, Aonahata M, Chida K; et al. (2001). "Successful treatment of eosinophilic gastroenteritis with suplatast tosilate". J Allergy Clin Immunol. 107 (5): 924–5. PMID 11344364.